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May Fong Mak Center for Surgery of the Foot & Ankle, Hirslanden Clinique La Colline, Switzerland; Department of Orthopaedics, Waikato Hospital, New Zealand

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Richard Stern Center for Surgery of the Foot & Ankle, Hirslanden Clinique La Colline, Switzerland

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Mathieu Assal Center for Surgery of the Foot & Ankle, Hirslanden Clinique La Colline, Switzerland

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Introduction The operative goal in the treatment of ankle fractures is well established: to restore anatomy and stability for early movement and full functional recovery, and prevent post-traumatic arthritis. However, the surgical approach

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Mario Herrera-Pérez Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
School of Medicine, Universidad de La Laguna, Tenerife, Spain

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Pablo Martín-Vélez Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain

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David González-Martín Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
School of Medicine, Universidad de La Laguna, Tenerife, Spain

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Miguel Domínguez-Meléndez Foot and Ankle Unit, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain

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Ahmed E Galhoum Specialty Doctor Trauma and Orthopaedics, George Eliot Hospital NHS Trust, Nuneaton, UK

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Victor Valderrabano Schmerzklinik, Basel, Switzerland
University of Basel, Basel, Switzerland

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Sergio Tejero Foot and Ankle Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
School of Medicine, Universidad de Sevilla, Sevilla, Spain

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condition of the patient. Frailty is accelerating with the aging of the population, affecting between 25 and 50% of adults aged 85 years ( 1 , 2 , 3 , 4 , 5 ), consequently, osteoporotic ankle fractures in frail patients are increasingly frequent in

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Duy Nguyen Anh Tran The International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam

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Bao Tu Thai Nguyen The International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam

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Tan Thanh Nguyen Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam

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Yu-Pin Chen Department of Orthopedics, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

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Yi-Jie Kuo Department of Orthopedics, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

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‘tobacco’ in conjunction with ‘ankle fracture’, ‘foot fracture’, or ‘calcaneus fracture’, and ‘infection’ or ‘SSI’. No time or language restrictions were applied, and studies published through April 2023 were candidates for inclusion. Screening of titles

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Mustafa S. Rashid Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK

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Yves Tourné Institut Grenoblois de Chirurgie du Pied, Echirolles, France

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Kar H. Teoh Princess Alexandra Hospital, Harlow, UK

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studies. In most foot and ankle fractures, osteotomies, and fusions, delayed union is defined as > 3 months since injury/operation and nonunion is > 9 months since injury/operation. ‘Normal’ time to union varies in foot and ankle fractures and radiographic

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Mehnoor Khaliq Leeds Orthopaedic & Trauma Sciences, School of Medicine, University of Leeds, Leeds, England

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Vasileios P Giannoudis Leeds Orthopaedic & Trauma Sciences, School of Medicine, University of Leeds, Leeds, England

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Jeya Palan Leeds Teaching Hospitals NHS Trust, Leeds, England

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Hemant G Pandit Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England

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Bernard H van Duren Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England

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 Treated ankle fractures 2-6.6 weeks  Cast immobilisation Conflicting evidence – avoid driving if right side casted versus no recommendations given Upper limb  Cast immobilisation of left arm Avoid driving while casted  Splints

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Fabian Tobias Spindler Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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Wolfgang Böcker Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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Hans Polzer Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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Sebastian Felix Baumbach Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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Introduction Syndesmotic injuries occur in 20% of ankle fracture cases and in approximately 17% of all ankle sprains ( 1 , 2 , 3 , 4 ). Isolated syndesmotic injuries are referred to as high ankle sprains. These figures rise to up to 30% in

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Maria Anna Smolle Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Lukas Leitner Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Nikolaus Böhler Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria

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Franz-Josef Seibert Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Mathias Glehr Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Andreas Leithner Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Retrospective study Both 185 721 Postoperative infection following ORIF for ankle fractures IV Lack et al (2015) 50 Retrospective study Both 39 98 Postoperative infection following ORIF for open tibial fracture IV Li et al (2020

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Jorge de-las-Heras Romero Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Avda Intendente Jorge Palacios 1, Murcia 30003, Spain

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Ana María Lledó Alvarez Regional Statistical Center, Treasury and public administration council, Murcia, Spain

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Fernando Moreno Sanchez Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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Alejandro Perez Garcia Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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Pedro Antonio Garcia Porcel Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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Raul Valverde Sarabia Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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Marina Hernandez Torralba Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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. Foot Ankle 1992 ; 13 : 44 - 50 . 22 Albers GHR de Kort AFCC Middendorf PRJM van Dijk CN . Distal tibiofibular synostosis after ankle fracture. A 14-year follow-up study . J Bone Joint Surg [Br] 1996 ; 78-B

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F T Spindler Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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V Herterich Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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B M Holzapfel Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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W Böcker Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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H Polzer Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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S F Baumbach Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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Introduction Isolated injuries to the syndesmotic complex occur in approximately 1–17% of all ankle sprains ( 1 , 2 ) and in up to 30% in high-impact sports ( 3 ). Furthermore, the syndesmosis is injured in up to 13% of all ankle fractures

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John-Henry Rhind Robert Jones Agnes Hunt Hospital, Oswestry, Shropshire, UK

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Eamon Ramhamadany Robert Jones Agnes Hunt Hospital, Oswestry, Shropshire, UK

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Ruaraidh Collins Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UK

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Siddharth Govilkar Robert Jones Agnes Hunt Hospital, Oswestry, Shropshire, UK

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Debashis Dass Robert Jones Agnes Hunt Hospital, Oswestry, Shropshire, UK

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Stuart Hay Robert Jones Agnes Hunt Hospital, Oswestry, Shropshire, UK

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finger injuries, 41 ankle fractures 47 and paediatric fractures. 48 Research in this area thus suggests that many of the injuries described in the current BOA pandemic advice have been previously successfully managed using the VFC model

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